Trichoscopy for the Hair Transplant Surgeon—Assessing for Mimickers of Androgenetic Alopecia and Preoperative Evaluation of Donor Site Area

Preoperative diagnostic confidence and donor site assessment are important for all hair transplant surgery patients. While the majority of patients seek hair transplantation for male or female pattern hair loss (androgenetic alopecia [AGA]), there are mimickers that must be differentiated from patterned hair loss, as they alter the candidacy of the patient for transplantation. They are termed mimickers as they also can present with patterned hair loss. The use of trichoscopy has become increasingly popular for such use. Patterned hair loss mimickers, which include the underappreciated alopecia areata incognita (AAI) and fibrosing alopecia in patterned distribution (FAPD), can be identified clinically with key trichoscopic findings such as yellow dots and peripilar casts, respectively, that correlate with their histologic diagnosis. Donor hair density and putative hair pathology of the safe donor area can also by assessed via trichoscopy. This article discusses the use of trichoscopy, particularly for diagnosing mimickers of patterned hair loss as well as preoperative donor site assessment.     

Regenerative Medicine Treatments for Androgenetic Alopecia

Regenerative medicine and the role of stem cells are being studied for applications in nearly every field of medicine. The pluripotent nature of stem cells underlies their vast potential for treatment of androgenic alopecia. Several advances in recent years have heightened interest in this field, chief among them are the evolution of simpler techniques to isolate regenerative elements and stems cells. These techniques are easy, outpatient procedures with immediate injection, often single session with harvest, and minimal manipulation (usually physical). This paper seeks to critically review the existing data and determine the current evidence and their role in practice.     

Comparison of Dermoscopic Findings in Female Androgenetic Alopecia and Telogen Effluvium and Female Controls in a Tertiary Care Center

BackgroundFemale androgenetic alopecia (FAGA) is a patterned hair loss caused by progressive miniaturization of hair follicles. This leads to reduction in the number and thickness of hairs, especially in the central, frontal, and parietal scalp regions. Telogen effluvium (TE) is characterized by diffuse hair loss within months of a significant systemic stressor because of premature follicular transition from the anagen to the telogen.ObjectiveThis article aims to highlight the dermoscopic differences between TE and FAGA compared to healthy female controls.MethodsA total of 124 female patients, which included 31 women with clinical diagnosis of FAGA, 33 with TE, and 60 controls, were enrolled. Two dermatologists independently assessed each patient clinically as well as with dermoscope, recorded the history and examination findings on a proforma, and made a diagnosis. These dermoscopic images were later revised in photographs on the computer.ResultsThere was a statistically significant difference in hair diameter diversity (HDD) between patients with FAGA versus TE and FAGA versus controls (p<0.0001). The difference in the mean percentage of single PSU in both frontal and occipital areas in FAGA versus controls and FAGA versus TE patients was statistically significant. The vellus hair were significantly higher in the FAGA patients than TE and control.ConclusionDermoscopic features of FAGA and TE will help in early detection on the basis of increased proportion of thin and vellus hairs, HDD, perifollicular discoloration, and the presence of a variable number of yellow dots.     

穴位放血疗法联合微针配合米诺地尔治疗进展期雄激素性秃发疗效分析

目的:探讨穴位放血疗法联合微针配合米诺地尔治疗进展期雄激素性秃发的疗效。方法:将2016年1月-2018年1月笔者科室门诊收治的85例男性进展期雄激素性秃发患者随机分成两组,联合组(放血疗法联合微针配合米诺地尔)43例和对照组(微针配合米诺地尔)42例。比较两组患者治疗3个月、6个月后的疗效、毛发密度及血清睾酮(T)、双氢睾酮(DHT)、性激素结合球蛋白(SHBG)及游离睾酮(FT)水平,比较两组患者停药后的复发情况及治疗期间出现的不良反应。结果:治疗3个月、6个月后,联合组患者总有效率均明显高于对照组,终毛密度与总毛发密度均明显高于对照组(P<0.05),毳毛密度与对照组患者相比,差异无统计学意义(P>0.05);治疗3个月、6个月后,联合组患者DHT、FT水平比对照组明显降低,SHBG水平比对照组明显升高(P<0.05);T水平与对照组相比,差异无统计学意义(P>0.05);停药12个月后,联合组患者的总复发率低于对照组患者(P<0.05),联合组患者治疗期间不良反应发生率低于对照组患者(P<0.05)。结论:穴位放血疗法联合微针配合米诺地尔治疗进展期雄激素性秃发患者疗效确切,不仅可以明显增加患者头发密度、降低复发率,还可以平衡患者的性激素,且安全性高。     

自体头发单体毛囊移植治疗永久性秃发的疗效评价

目的采用自体枕部头发分离成单体毛囊，移植治疗永久性秃发（雄激素源性秃发及瘢痕性秃发），评价其效果。方法取患者自体枕部的头发优势区的毛发，在手术放大镜下将其分成含有1～4根毛发的单体毛囊，用小植发刀在受区根据术前设计作2mm的小切口，用显微手术镊取已分离好的单体毛囊，植入切口内。结果我科于2003年10月至2007年10月共手术163例，大部分患者术后移植的毛发均生长良好。结论自体毛发单体毛囊移植术治疗永久性秃发，手术效果好，手术创伤小，外观较满意。     

微针联合米诺地尔酊对雄激素性脱发患者临床疗效影响

目的 探究在雄激素性脱发患者中实施微针联合米诺地尔酊治疗的效果。方法 选取雅诗兰黛上海 商贸有限公司2022年5月-2023年6月招募的50例雄激素性脱发受试者为研究对象,采用随机数字表法分为 对照组和观察组,各25例。对照组采用米诺地尔酊治疗,观察组采用微针联合米诺地尔酊治疗,比较两组 临床疗效、毛发镜数据、主观症状评分及毛发生长情况。结果 观察组总有效率为96.00%（24/25）,高于 对照组的76.00%（19/25）（P ＜0.05）;观察组治疗12周后粗发数量、毛发密度高于对照组,细发数量、 毳毛比例低于对照组（P ＜0.05）;观察组毛发生长速度、生长长度优于对照组（P ＜0.05）;观察组治疗 12周后油腻、鳞屑、瘙痒评分高于对照组（P ＜0.05）。结论 采取微针联合米诺地尔酊治疗雄激素性脱发 的效果较好,能提高临床疗效,改善主观症状评分,促进毛发生长,值得临床应用。     

Low‐level laser (light) therapy (LLLT) for treatment of hair loss

Objective

Alopecia is a common disorder affecting more than half of the population worldwide. Androgenetic alopecia, the most common type, affects 50% of males over the age of 40 and 75% of females over 65. Only two drugs have been approved so far (minoxidil and finasteride) and hair transplant is the other treatment alternative. This review surveys the evidence for low‐level laser therapy (LLLT) applied to the scalp as a treatment for hair loss and discusses possible mechanisms of actions.

Methods and Materials

Searches of PubMed and Google Scholar were carried out using keywords alopecia, hair loss, LLLT, photobiomodulation.

Results

Studies have shown that LLLT stimulated hair growth in mice subjected to chemotherapy‐induced alopecia and also in alopecia areata. Controlled clinical trials demonstrated that LLLT stimulated hair growth in both men and women. Among various mechanisms, the main mechanism is hypothesized to be stimulation of epidermal stem cells in the hair follicle bulge and shifting the follicles into anagen phase.

Conclusion

LLLT for hair growth in both men and women appears to be both safe and effective. The optimum wavelength, coherence and dosimetric parameters remain to be determined. Lasers Surg. Med. 46:144–151, 2014. © 2013 Wiley Periodicals, Inc.     

氧化压力与头发老化的相关性研究进展

氧化压力作为被普遍认可的人类老化的重要因素,在头发和头皮老化中也扮演了重要的角色。主要的脱发类型雄性激素脱发,压力型脱发和衰老型脱发均和氧化压力有不同程度的关系,而对于头发的灰白化,氧化压力是黑素细胞凋亡,黑色素生成减少的核心机制,毛囊黑素细胞和表皮黑素细胞相比经受更大的氧化压力;头屑和头皮敏感人群,尤其是油脂分泌旺盛导致的头屑和头皮敏感,脂质、氧化压力在其中扮演了重要角色。总而言之,氧化压力和头发头皮衰老的各种症状密切相关,在开发头发和头皮老化解决方案时,需要全面考虑抗氧化机制的应用。本文就氧化压力和脱发、头发灰白化,头屑和头皮敏感的关系等方面论述了国内外目前在该领域的研究进展。     

Patient Satisfaction and Quality of Life Among Adult Women with Androgenetic Alopecia Using 5% Topical Minoxidil

BACKGROUND: Androgenetic alopecia (AGA) is a common, genetically predisposed condition that begins after puberty and whose frequency increases with age; although biologically benign, AGA can impact patients both psychologically and socially, contributing to an impairment on their quality of life. OBJECTIVE: We sought to evaluate the psychological, social, and quality of life impairments inherent in women with AGA using 5% minoxidil daily for at least six months. DESIGN: Thirty-one women with diffuse central hair thinning and shaft miniaturization who were using 5% minoxidil daily for at least six months responded to a clinical questionnaire and underwent trichoscopy. RESULTS: 83.9 percent (n=26) of the participants reported they were satisfied with the 5% minoxidil treatment and its convenience. Hair loss influenced social life in 54.8 percent (n=17) of the respondents and choice of hair cut/hairstyle in 87.1 percent (n=27) of respondents. For 51.6 percent (n=16) hair loss was slightly increased, although it did not increase after beginning treatment. A frontoparietal pattern (74.2%, n=23), very low capillary density (61.3%, n=19), trichodynia (32.3%, n=10), and negative traction test (100%, n=31) were also observed. Miniaturization occurred in 100 percent (n=31) of patients, frontal/occipital hair thickness was reduced in 83.9 percent (n=26), and more than 10 percent of velus hair in the frontal area was observed in 83.9 percent (n=26) of patients. The number of hair shafts per follicular unit was reduced in 67.7 percent (n=21), and a higher frontal to occipital ratio of follicular units with one hair shaft was seen in 74.2 percent (n=23) of patients. Empty follicles, large numbers of peripillar brownish halo, scalp pigmentation, mild Ludwig''s baldness degree, and quality of life scores of 4±3.5 points were observed. CONCLUSION: Our results indicate that patient satisfaction and quality of life of women with AGA on 5% topical minoxidil are high, although hair loss influences daily habits and social life.     

非那雄胺联合A型肉毒毒素注射治疗雄激素性脱发的临床效果

观察非那雄胺联合A型肉毒毒素注射治疗雄激素性脱发（AGA）的有效性及安全性。方法 选择2021年6月-2022年8月浙江大学医学院附属邵逸夫医院收治的47例男性AGA患者为研究对象,随机分 为对照组23例和观察组24例,对照组采用A型肉毒毒素注射治疗,观察组采用非那雄胺联合A型肉毒毒素 注射治疗,比较两组毛发密度、终毛/毳毛数量比例、生活质量及不良反应发生情况。结果 观察组治疗3、 6个月后毛发密度评分均高于对照组（P ＜0.05）;两组治疗3、6个月后终毛/毳毛比例比较,差异无统计学 意义（P＞0.05）;观察组头皮油腻度、瘙痒、鳞屑、脱发评分均高于对照组（P＜0.05）;两组均未出现明 显、严重副作用及不良反应。结论 非那雄胺联合A型肉毒毒素注射治疗AGA的临床效果良好,可提高患者 的毛发密度,改善其生活质量,且应用安全性较高。     

新生植发3D技术治疗瘢痕秃发的效果

目的 分析新生植发3D技术在瘢痕秃发患者中的应用效果。方法 选取本院2020年2月-2022年2月 收治的60例瘢痕秃发患者为研究对象,随机分为对照组和观察组,各30例。对照组予以常规FUE毛发移植 治疗,观察组予以新生植发3D技术治疗,比较两组毛发覆盖率、临床疗效、负面情绪、生活质量及手术 满意度。结果 观察组毛发覆盖率高于对照组（P＜0.05）;观察组治疗总有效率为100.00%,高于对照组的 86.67%（P ＜0.05）;观察组治疗后SAS评分、SDS评分均低于对照组（P ＜0.05）;观察组SF-36各维度评 分均高于对照组（P＜0.05）;观察组手术满意度为100.00%,高于对照组的83.33%（P＜0.05）。结论 相比 于FUE毛发移植治疗,新生植发3D技术治疗瘢痕秃发的效果更为理想,可提高毛发覆盖率,减轻患者的负 面情绪,提高手术满意度,同时有利于改善患者的生活质量。     

A Systematic Review and Meta-analysis of Randomized Controlled Trials of United States Food and Drug Administration-Approved,Home-use,Low-Level Light/Laser Therapy Devices for Pattern Hair Loss: Device Design and Technology

BackgroundLow-level light/laser therapy (LLLT) can potentially stimulate hair growth in pattern hair loss (PHL), with many available home-use LLLT devices of different designs and technology on the market. However, not all devices are cleared by the United States (US) Food and Drug Administration (FDA), with very few studies to support their efficacy.ObjectivesThis systematic review and meta-analysis aimed to investigate the effectiveness of FDA-approved LLLT devices for PHL treatment.MethodsWe included articles related to FDA-approved home-use LLLT devices on PubMed and Medline, using the FDA 510(K) Premarket Notification database and the systematic search of articles up to January 2020. The standardized mean difference (SMD) for the changes of hair density treated by LLLT versus sham devices was analyzed.ResultsOnly 32 home-use LLLT devices have been approved by the FDA as of January 2020. The meta-analysis comprised seven double-blinded, randomized, controlled trials. The overall quantitative analysis yielded a significant increase in hair density in those treated by LLLT versus sham groups (SMD: 1.27, 95% confidence interval [CI]: 0.993–1.639). The subgroup analysis demonstrated the increased hair growth in male and female subjects with both comb- and helmet-type devices. There were significant LLLT sources in the LDs alone (SMD: 1.52, 95% CI: 1.16–1.88) and the LDs combination (SMD: 0.85, 95% CI: 0.55–1.16) (p=0.043).ConclusionLLLT is potentially effective for PHL treatment. Nonetheless, the long-term follow-up study in patients with severe PHL with combined standard treatment and comparison between LLLT devices and energy sources is recommended.     

5%米诺地尔擦剂+梅花针针刺法+激光生发仪照射治疗 男性雄激素性脱发的效果

目的 分析5%米诺地尔擦剂+梅花针针刺法+激光生发仪照射治疗男性雄激素性脱发的效果。 方法 选取2021年11月-2022年6月我院皮肤科门诊收治的90例雄激素性脱发男性患者为研究对象,按照随机 数字表法分为A、B、C三组,每组30例。A组予以5%米诺地尔擦剂+梅花针针刺法+激光生发仪照射,B组予 以5%米诺地尔擦剂+激光生发仪照射,C组予以5%米诺地尔擦剂+梅花针针刺法,通过毛发镜检测技术比较 三组治疗前后左侧额角、右侧额角、头顶部的毛发密度、毛发直径变异率、含单根毛发的毛囊单位比例、毛 干平均直径变化。结果 三组治疗后左侧额角、右侧额角、头顶部的毛发密度、毛发直径变异率、含单根毛 发的毛囊单位比例、毛干平均直径变化均优于治疗前（P＜0.05）;A组改善毛发密度、降低毛发直径变异率 优于B、C组;改善头顶部含单根毛发毛囊比例方面优于B组;改善左侧额角、右侧额角、头顶部含单根毛发 毛囊比例方面优于C组（P＜0.05）。结论 5%米诺地尔擦剂+梅花针针刺法+激光生发仪照射的联合疗法治疗 男性雄激素性脱发的效果更佳,毛发生发速度更快,可降低毛发直径变异率,值得临床应用。     

Koilonychia in a Patient with Alopecia Areata

Alopecia areata (AA) is an autoimmune disease that affects the hair follicles and leads to nonscarring alopecia. Nails changes are a common manifestation in AA, with an average prevalence of 30 percent. Both nail changes and hair loss in AA are associated with lymphocytic inflammation and are thought to be a result of a loss of immune privilege in both hair follicle and nail apparatus. Koilonychia, or “spoon nails,” is a nail dystrophy where the nail plate is depressed centrally and everted laterally. Causes of nail spooning are various, but koilonychia is usually associated with iron deficiency and inflammatory dermatoses, such as psoriasis and lichen planus. Koilonychia is very rarely reported in association with AA in the English literature and its prognostic significance is still unknown. We report a case of a 25-year-old female patient who presented with AA focalis and koilonychia that regressed almost completely after oral corticosteroids, with an accompanying discussion of the pathogenesis and prognostic value of koilonychia.     

斑秃118例临床分析

目的　探讨斑秃的好发年龄、性别分布、诱因、自觉症状、伴随症状与伴发疾病及上述因素与病情严重程度的关系。方法　收集中南大学湘雅二医院、湘雅三医院门诊斑秃患者的临床资料进行分析 ,比较男女患者在患病年龄和病情上的差异 ;比较病情严重程度与自觉症状、伴随症状、精神因素等的相关性。结果　共收集患者 1 1 8例 ,男 6 4例 ,女 5 4例 ,男女比例为 1 .2∶1 .0 ,病情严重程度与性别无关 ;患病年龄 1～ 76岁 ,平均年龄 (31 .3± 1 .3)岁 ,女性患者平均年龄为 (2 8.9± 1 .9)岁 ,男性为 (33.2±1 .8)岁 ;病程 1d至 1 1年 ,平均病程 2 .5个月 ,限局性斑秃为 2个月 ,全秃 /普秃为 1 8个月 ;1 4 .4 %的患者 (1 7/ 1 1 8)有局部症状 ,其中限局性斑秃 1 1例 ,全秃 /普秃 6例 ;2 0 .3%的患者 (2 4 / 1 1 8)起病前有精神因素 ,6 0 .2 %的患者 (71 / 1 1 8)睡眠不佳 ,1 5 .2 %的患者 (1 8/ 1 1 8)伴趾甲改变 ,5 .9%的患者 (7/ 1 1 8)伴眼部症状 ,5 .9%的患者 (7/ 1 1 8)有家族史 ,3.4 %的患者 (4/ 1 1 8)伴甲状腺疾患 ,1 .7%的患者 (2 / 1 1 8)伴白癜风 ,4 .8%的患者 (3/ 6 2 )甲状腺球蛋白抗体 (TGA)、甲状腺微粒抗体 (TMA)异常。结论　斑秃两性患病率接近 ,病情与性别无关 ;好发年龄为中青年 ,女性患病年龄     

Beware of the Impostors—Scalp Pathology Primer for the Hair Transplant Surgeon

Histopathological features are important for the practicing hair transplant surgeon to ensure proper case selection, diagnosis, choice of proper treatment, and successful outcome. While the primary focus of the hair transplant surgeon is androgenetic alopecia (AGA), it is important to be aware of other conditions that can mimic AGA, whose treatment may be different. This article outlines some of these conditions such as scarring alopecias, alopecia areata, etc., and how to distinguish them. Proper identification will ensure proper treatment and avoid potential missteps in management.     

影响雄激素源性脱发疗效的相关因素分析

目的：回顾204例定期随访的门诊雄激素源性脱发（androgenic alopecia,AGA）患者的病例资料,分析影响疗效的相关因素。方法：采用SAS8.0分析疗效与疾病严重程度、病程、发病年龄、治疗时间、治疗方式等的相关性。结果：患者多为病程在5年内、严重程度为中度的男性;患者评价和医生评价结果显示,疗效与用药时间相关系数分别为0.36和0.40,与严重程度相关系数为0.276和0.287,均P〈0.01;疗效与发病年龄相关系数小于0.2,与病程相关的P〉0.01。说明疾病严重程度越重的、治疗时间越长的,疗效越明显。从治疗方式上看,联合治疗有效率最高,单纯口服次之,单纯外用最低。结论：疗效与病情严重程度和治疗时间呈正相关,而与病程、发病年龄等无明显相关性。联合治疗较单独口服或者外用治疗效果更好。